[Aortic coarctation. Indications and results of surgical treatment. 16 years of experience].

Eighty-nine patients were treated surgically for coarctation of the aorta in a period of 16 years. In 79, the operative procedure consisted of excision of the coarcted segment and primary anastomosis; in 7 cases of hypoplastic arch and in 3 of aneurysm of the aorta, some form of aortoplasty utilizing the isthmus and the subclavian artery, or the use of a dacron prosthesis were required. In a group of 33 patients under 2 years, 76% had associated cardiac anomalies and 100% heart failure, which made immediate surgical treatment mandatory with a mortality of 42% and a recoarctation rate of 10.5%. Out of 56 cases over 2 years, 46% had other cardiac malformations; however, a less severe clinical conditions allowed for an elective operation, with a mortality of 1.8% and a recoarctation rate of 1.8%. This experience and the review of the literature support the concept of elective surgical treatment for coarctation of the aorta around the age of 4 years, prior to the occurrence of hypertension or its complications. In the neonate and infant, surgery is justified in the presence of heart failure non-responsive to medical treatment within 24 to 48 hours. A deeper understanding of the pathophysiology of the malformation in the very young and a better perioperative management of neonates, have led to a decline in mortality in recent years.